They measured a panel of 50 measures of exposure to nicotine as well carcinogens and heavy metals.

The point that e-cigarette enthusiasts will likely emphasize from the paper is that the measures of many of these toxins were lower in the e-cigarette users than the smokers. (They were also higher than in people who did not use any product, as expected.)

The most interesting and troubling finding is that the levels of 47 of the 50 chemicals were higher in the dual users (people who used both products at the same time) and 76% of the e-cigarette users were dual users (i.e., still smoking cigarettes). Of these 47, 28 were statistically significantly higher in the dual users than the people who just smoked cigarettes. (The levels of the other 3 chemicals were about the same in both groups.)

December 21, 2018

PMI finally responded to my paper in Tobacco Control1 showing that the data submitted in their MRTP application to the FDA to market IQOS with reduced risk claims did not actually support claims of reduced risks.

Specifically, PMI’s MRTP application included their 3-month study of 24 non-cancer biomarkers of potential harm (which PMI calls “clinical risk endpoints,” CRE) in humans using IQOS compared to conventional cigarettes. These biomarkers include measures of inflammation, oxidative stress, lipids, blood pressure, and lung function. (PMI did separate studies of biomarkers of exposure, several of which are carcinogens.) While PMI’s application emphasizes that these biomarkers generally changed in positive directions, my examination of the data revealed no statistically detectable difference between IQOS and conventional cigarettes for 23 of the 24 BOPH in Americans and 10 of 13 in Japanese. Moreover, it is likely that the few significant differences were false positives. Thus, despite delivering lower levels of some toxicants, PMI’s own data failed to show consistently lower risks of harm in humans using IQOS compared to conventional cigarettes.

December 21, 2018

Here is what VCU Professor and expert on e-cig products Thomas E Eissenberg has to say about Juul and how its formulation can spread:

Actually, and perhaps worringly, I don't think JUUL is exceptional at all. Their innovation, such as it is, is the observation that protonated nicotine ("salt") is more palatable in aerosol form than freebase nicotine, making their ~60 mg protonated liquid easier to inhale than if it were freebase (I doubt anyone would willingly inhale aerosolized 60 mg/ml freebase liquid at 8W; 36 mg is borderline aversive). The scary thing for those of us worried about nicotine dependence is that salt liquids are now available on the market (at least in the US) such that ANY device can now be used to produce this highly palatable, high nicotine content aerosol. And, perhaps more concerning, those highly palatable, high nicotine content liquids can be used in devices that achieve much greater power output than the current ~8W JUUL. So, if JUUL were to disappear tomorrow, users could migrate to protonated liquids that they buy in bottles, put them in their high wattage devices, and achieve even greater nicotine delivery than JUUL provides today.

November 30, 2018

The New York Times recently reported that Juul is working to develop a pod with lower nicotine content that will deliver the same “hit” by increasing the voltage in the device. Running at a higher temperature increases nicotine delivery, as well as generation of the other toxic chemicals in e-cigarettes.

This effort to sidestep EU rules on nicotine in e-cigarettes is one more illustration of how Juul is acting like any other tobacco company in working to get around the rules. The fact that they are modifying the product in a way that increases the risks is especially cynical given that they claim to be interested in harm reduction.